Peripartum Decompensation of an Orbital Vascular Malformation Managed With Urgent Postpartum Surgical Decompression.
Malcolm M Kates, Gerald J Harris
✦ AI-curated · Sources linked
Case in brief
A 36-year-old woman at 36 weeks’ gestation developed months of pain on upgaze and progressive right-eye visual loss. Examination showed 20/200 acuity, a relative afferent pupillary defect, proptosis, restricted motility, optic disc edema, and visual field loss. MRI demonstrated a lobulated mass at the superolateral orbital apex; possibilities included a vascular malformation enlarged with gestational hypervolemia and a hormonally sensitive meningioma. After induced delivery, imaging and partial visual recovery favored a vascular lesion. Urgent endoscopic transethmoidal decompression restored acuity to 20/20-1; by 4 months postpartum, the lesion had regressed and examination findings had normalized.
What made this case unusual
The orbital mass caused severe optic nerve dysfunction late in pregnancy, with imaging initially unable to distinguish a gestationally enlarged vascular malformation from a hormonally sensitive meningioma.
Diagnostic / clinical pearl
In a pregnant patient with progressive visual loss and an orbital apex mass, consider a vascular malformation that may enlarge during gestation; postpartum imaging and clinical change can help clarify the diagnosis.
Why it matters
The case illustrates coordinated obstetric and ophthalmic management when waiting for postpartum lesion regression may not reliably protect vision.